INTRODUCTION Risk factors for carbapenemase-producing Enterobacterales (CPE) acquisition/infection and associated clinical outcomes have been evaluated in the context of clonal, species-specific outbreaks. Equivalent analyses for complex, multi-species outbreaks, which are increasingly common, are lacking. METHODS Between December 2010 and January 2017, a case-control study of Klebsiella pneumoniae carbapenemase (KPC)-producing organism (KPCO) acquisition was undertaken using electronic health records from inpatients in a US academic medical centre and long-term acute care hospital (LTACH) with ongoing multi-species KPCO transmission despite a robust CPE screening programme. Cases had a first KPCO-positive culture >48 h after admission, and included colonizations and infections (defined by clinical records). Controls had at least two negative perirectal screens and no positive cultures. Risk factors for KPCO acquisition, first infection following acquisition, and 14-day mortality following each episode of infection were identified using multi-variable logistic regression. RESULTS In 303 cases (89 with at least one infection) and 5929 controls, risk factors for KPCO acquisition included: longer inpatient stay, transfusion, complex thoracic pathology, mechanical ventilation, dialysis, and exposure to carbapenems and β-lactam/β-lactamase inhibitors. Exposure to other KPCO-colonized patients was only a risk factor for acquisition in a single unit, suggesting that direct patient-to-patient transmission did not play a major role. There were 15 species of KPCO; 61 (20%) cases were colonized/infected with more than one species. Fourteen-day mortality following non-urinary KPCO infection was 20% (20/97 episodes) and was associated with failure to achieve source control. CONCLUSIONS Healthcare exposures, antimicrobials and invasive procedures increased the risk of KPCO colonization/infection, suggesting potential targets for infection control interventions in multi-species outbreaks. Evidence for patient-to-patient transmission was limited.

中文翻译：

---

跨多种细菌的肺炎克雷伯氏菌碳青霉烯酶（KPC）基因获得和临床结果的危险因素。

引言在克隆性，物种特异性暴发的背景下，已经评估了产生碳青霉烯酶的肠杆菌（CPE）采集/感染的风险因素以及相关的临床结果。缺乏对复杂，多物种暴发的等效分析，这种分析越来越普遍。方法在2010年12月至2017年1月之间，使用美国学术医学中心和长期急性护理医院（LTACH）住院患者的电子健康记录进行了产肺炎克雷伯菌碳青霉烯酶（KPC）收购生物（KPCO）的病例对照研究。 ），尽管有强大的CPE筛查计划，但仍在持续进行多种KPCO传播。病例在入院后48小时内首次出现KPCO阳性培养，包括定植和感染（由临床记录定义）。对照组至少有两个阴性直肠周围筛查，而没有阳性培养物。使用多变量logistic回归分析确定了KPCO采集，采集后首次感染以及每次感染后14天死亡率的危险因素。结果在303例病例（其中89例至少感染1例）和5929例对照中，获得KPCO的危险因素包括：住院时间更长，输血，胸廓病理复杂，机械通气，透析以及接触碳青霉烯和β-内酰胺/β-内酰胺酶抑制剂。暴露于其他KPCO殖民化患者仅是在单个病房中获得疾病的危险因素，这表明直接的患者间传播并未发挥主要作用。KPCO有15种。61（20％）例被一种以上的物种定殖/感染。非尿KPCO感染后14天死亡率为20％（20/97次发作），并且与无法实现源控制有关。结论医疗保健接触，抗菌药物和侵入性程序增加了KPCO定植/感染的风险，这表明在多物种暴发中采取感染控制干预措施的潜在目标。病人之间传播的证据有限。